AWARD TIMELINE
23rdAnnual
Awards
Applications Available Online January 1, 2017
WISCONSIN CORPORATE SAFETY
Applications Deadline
Apply Online: www.wisafetycouncil.org
Phase I: Statistical Data January 20, 2017
2016 AWARDS PROGRAM
Finalists Notified January 27, 2017
WHY APPLY?
Phase II: Subjective Report February 17, 2017 Winners Notified March 15, 2017 Awards Presented April 11-12, 2017 Awards presented during the 75th Annual Wisconsin Safety and Health Conference & Expo in Wisconsin Dells
The Awards Program is sponsored by:
• Winning a corporate safety award is an excellent recognition tool and provides opportunities for new business thanks to the prestige and exposure of the award. • This program gives much deserved recognition to your employees for their loyalty, hard work and dedication. • Leading companies like yours deserve the opportunity to be recognized as a leader in workplace safety efforts. • Exclusivity – winning this award places you in an elite group of fewer than 200 Wisconsin companies who have won in the 22 years this program has been honoring deserving organizations. • Nominees and winners alike have received substantial and deserved recognition in the media locally, statewide and beyond. • This awards program highlights significant accomplishments and industry firsts of those companies leading the way for future generations. • The application process allows you to fully assess your organization – a valuable tool because it helps you evaluate your safety program’s strengths and improve upon weaknesses.
Now easier than ever, the streamlined CSA application process can be fully completed online at www.wisafetycouncil.org. Each CSA application includes: • Phase I: Quantitative data relating to your company’s incidence rates for the past three years straight from your OSHA 300 logs • Phase II: Qualitative data given to the qualified finalists to tell your company’s safety narrative Questions? Contact Janie Ritter, WSC, 800.236.3400
CELEBRATING SAFETY IN WISCONSIN!
23rdAnnual
WISCONSIN CORPORATE SAFETY
Awards
This is a sample only. Official applications must be submitted online at www.wisafetycouncil.org
PHASE I — STATISTICAL DATA FORM
The information will only be used by the Wisconsin Safety Council and judges of the 2016 Wisconsin Corporate Safety Award
Questions? Contact Janie Ritter, Director Email: jritter@wisafetycouncil.org Phone: 800.236.3400
Company_______________________________________________________________________________ Company (as you would like it to appear)_______________________________________________________ Contact Person __________________________________________________________________________ Title___________________________________________________________________________________ Street Address___________________________________________________________________________ City_______________________________________ State__________ Zip Code_______________________
LE
Phone Number_______________________________ Fax Number___________________________________ E-mail__________________________________________________________________________________ Year Established__________________________________________________________________________ Primary North American Industry Classification Code (NAICS) (see list online) ________________________________________________ Reporting as: Entire WI Organization
Separate Division/Operations Unit (see eligibility section)
2014
2016 (yes or no)
P
1. Worker fatalities in 2016 (see eligibility section)
2015
2. Average number of temporary/contract employees in 2016
2a. Number of temporary/contract employee hours worked
2b. Number of temporary/contract employee recordable cases
_______
_______
_______
4. Total number of hours worked
_______
_______
_______
M
3. Average number of employees on payroll
_______
_______
_______
5b. Column I (job transfer or restriction)
_______
_______
_______
5c. Column J (other recordable cases)
_______
_______
_______
5d. Total Column (H, I and J)
_______
_______
_______
_________
________
________
_________
________
________
S
5. Total number of recordable cases (from OSHA form 300) 5a. Column H (days away from work)
A
[Work Hours (WH) are the number of paid work hours for the calendar year (including office hours). PLEASE NOTE: WH are the actual payroll hours worked, excluding vacation and holidays. You must include all full-time, part-time, seasonal and temporary/contract employees that work under your organization’s supervision.]
6. If your answer to question #5a is zero, how far back does this record go? Date _____________________ Hours worked ________________ INCIDENCE RATE:
Enter Line 5d (above) x 200,000 = Rate
(RECORDABLE) INCIDENCE RATE:
Enter Line 4 Enter Line 5a (above) x 200,000 = Rate
(LOST WORKDAY CASE)
Enter Line 4
I hereby certify that the information included in this application form is factual and accurate. Completed by:___________________________________________________ (Please print or type name and title)
Submit application online www.wisafetycouncil.org
APPLICATION MUST BE RECEIVED BY FRIDAY, JANUARY 20, 2017.